I hear from a lot of parents whose kids have come out as transgender, including parents of teenagers or young adults. For some parents, it seems to be the missing puzzle piece that explains why their child always seemed a bit different, or uneasy. For other parents, it comes as a complete surprise, and parents may be in disbelief that this is really happening.

Here are some of the things I most frequently find myself discussing with parents in this situation:

Is my kid really transgender? Could it be that she is just hearing about this in the media a lot recently? Isn’t this just a phase?

We do watch kids go through all sorts of phases and try on all sorts of identities as they grow up. How do we know this isn’t just one more? Fair question. But coming out as transgender is extremely difficult, and not something anyone tends to do lightly. Consider also that deciding it must be a phase, or just the influence of media, may be a way to quickly dismiss something that’s making you uncomfortable.

I often ask parents, is this like your child? Are they highly susceptible to media messages? Are they always finding a new identity based on what they see on television, for instance? Do they have a history of reinventing themselves in drastic ways? If the answer is no, then I suggest putting these questions on the backburner for a bit while we explore some other possibilities.

How could I not have known this about my child?

Many parents feel they would have, or should have, seen signs of an alternative gender identity in their child before. There are a couple of good reasons why many parents don’t.

First, the idea that there are two genders, male and female, is deeply ingrained in most of us, as is the idea that gender is not something that can change. This expectation often acts as a filter through which we perceive people. It prevents us from seeing other possibilities.

Second, gender-based expectations are communicated to kids from a very early age. Kids come to understand how they are expected to present, and often they become very skilled at adapting to those expectations. Obvious gender-nonconforming traits are often hidden or discarded, sometimes for quite a long time.
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In short:
It’s not because you’re a bad parent, or you weren’t paying attention. It’s because our culture is still very devoted to limited views about gender.

I want to be supportive, but I’m an emotional mess, and I just wish this weren’t happening.

This makes so much sense. There are so many emotions to process in a situation like this! On a practical level, you may worry about your kid’s physical or emotional safety if they come out as transgender. You may worry that their peers, their family members, or the wider world will be hostile to them. You may worry about the logistics of gender transitions, which perhaps you are just starting to look into, and you are realizing there is so much to learn.

In my experience with most parents, the place that feels the most sensitive and frightening is this: You may feel like you are losing your child. You raised a girl, or a boy, and you had a vision about who they were and what the future would hold. Now perhaps it feels like that’s all gone, and you are facing a stranger. You want your kid back. Every parent I’ve worked with has expressed those feelings on some level, and this is the place where the most compassion for self is needed. You’re going through a grieving process, and it isn’t easy. It doesn’t mean you’re not being supportive. You just need a safe place to process those difficult feelings, either with trusted friends, in a support group, or with a therapist one on one.

It can help to know that gender transitions are a process, not an all at once proposition. The child you raised is still there. It usually takes transgender people time to work out where they want to be and what feels right. Taking a deep breath and slowing down is okay.

I do a number of consultations for transgender clients who have questions about changing documents, getting medical services, etc. Here are my answers to some of the most frequently asked questions.

How do I get started with hormone therapy?

There are several doctors here in the St. Louis area who are knowledgeable and experienced at providing hormone therapy for transgender clients. Typically, doctors require a referral letter from a therapist, stating that you qualify for a diagnosis of Gender Dysphoria, and that any other mental health concerns are being effectively addressed. In order to write a referral letter, a therapist will need to do a diagnostic evaluation. This is pretty routine and does not require a great deal of time.

I am happy to help clients who need assessments and referral letters for hormone therapy. Contact me for a consultation to talk through the process, and I can answer any additional questions you may have.

Can you recommend a doctor?

Yes! If you have health insurance, I may be able to suggest someone who is in-network. Give me a call, and let’s discuss.

What if I am interested in surgical procedures?

Depending on what type of surgery you are interested in, surgery may or may not involve traveling to another city. I always suggest finding a surgeon and having a consultation with them first. While all reputable physicians work to the same standards of care, different providers have different requirements for documentation. Some merely require the same letter I would write for a referral for hormone therapy. Others have a specific form they want filled out.

Why do I need to be diagnosed with something in order to get hormones or surgery?

Good question. The inclusion of Gender Dysphoria as a diagnosis is controversial, and the clinicians who worked on the latest version of the Diagnostic and Statistical Manual had serious concerns about it. The previous revision of the manual used the term “Gender Identity Disorder.” The term “disorder” was clearly inaccurate. Gender variance and gender fluidity are not disorders. The revised term at least acknowledges that. Many clinicians, including some of the authors of the manual, would like to see Gender Dysphoria removed from the DSM completely, as it is not a mental health condition. However, they also understood that having some sort of diagnosis is necessary for many people simply so that they can get the services they need. Many insurance companies only cover procedures and therapies they deem “medically necessary,” and in order to meet that requirement, documentation is required. We can expect the landscape to continue to evolve, hopefully in a better, more progressive direction.

How do I change my name, get my gender marker on my driver’s license changed, or update my passport?

It depends on where you live. Transequality.org/documents has a good rundown of the specifics on a state by state basis.